Table 1.
U.S. Ambulatory Care Visits Resulting in Cardiac Stress Test Order or Performance, by Demographic and Clinical Characteristics, 1993–2010*
| Annual Average, 1993–1995¶ | Annual Average, 2001–2003‖ | Annual Average, 2008–2010‡ | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Characteristic | Weighted No. in Thous.§ |
Test Rate per 10,000† |
95% CI | Weighted No. in Thous.§ |
Test Rate per 10,000† |
95% CI | Weighted No. in Thous.§ |
Test Rate per 10,000† |
95% CI | P for trend, unadj. |
P for trend, adj. |
OR, trend |
aOR, trend |
| All visits | 1,635 | 28 | (23 to 33) | 3,205 | 42 | (35 to 50) | 3,805 | 45 | (36 to 53) | 0.004 | 0.134 | 1.02 | 1.01 |
| Age, yrs | |||||||||||||
| 18–44 | 309 | 12 | (7 to 17) | 788 | 29 | (18 to 40) | 527 | 19 | (12 to 25) | 0.012 | 0.27 | 1.03 | 1.02 |
| 45–64 | 833 | 50 | (38 to 63) | 1,594 | 61 | (48 to 74) | 1,964 | 62 | (49 to 75) | 0.89 | 0.69 | 1.00 | 1.00 |
| 65–79 | 462 | 36 | (24 to 48) | 705 | 44 | (31 to 57) | 1,114 | 62 | (44 to 79) | 0.013 | 0.008 | 1.03 | 1.04 |
| >80 | 67 | 15 | (7 to 24) | 111 | 19 | (8 to 29) | 174 | 25 | (16 to 34) | 0.031 | 0.143 | 1.06 | 1.04 |
| Sex | |||||||||||||
| Female | 820 | 22 | (16 to 28) | 1,390 | 29 | (23 to 35) | 1,974 | 37 | (29 to 45) | 0.003 | 0.045 | 1.03 | 1.02 |
| Male | 815 | 38 | (30 to 47) | 1,815 | 64 | (49 to 79) | 1,831 | 58 | (45 to 71) | 0.078 | 0.61 | 1.02 | 1.01 |
| Race/ethnicity | |||||||||||||
| Non-Hispanic white | 1,218 | 30 | (23 to 37) | 2,012 | 44 | (34 to 53) | 1,964 | 44 | (34 to 53) | 0.056 | 0.89 | 1.02 | 1.00 |
| Non-Hispanic black | 128 | 25 | (10 to 40) | 306 | 54 | (26 to 83) | 216 | 30 | (15 to 45) | 0.20 | 0.41 | 1.03 | 1.02 |
| Hispanic | 77 | 19 | (8 to 30) | 209 | 36 | (17 to 54) | 305 | 44 | (26 to 63) | 0.04 | 0.141 | 1.05 | 1.04 |
| Other/unknown | 211 | 23 | (11 to 36) | 678 | 37 | (24 to 49) | 1,319 | 51 | (31 to 70) | 0.073 | 0.123 | 1.03 | 1.03 |
| Insurance | |||||||||||||
| Private | 742 | 35 | (26 to 44) | 2,127 | 51 | (40 to 63) | 2,171 | 49 | (38 to 59) | 0.186 | 0.81 | 1.01 | 1.00 |
| Medicare | 436 | 31 | (20 to 42) | 663 | 34 | (24 to 45) | 1,136 | 48 | (35 to 61) | 0.016 | 0.024 | 1.03 | 1.03 |
| Medicaid/Other | 421 | 26 | (16 to 35) | 287 | 26 | (13 to 39) | 404 | 33 | (16 to 50) | 0.76 | 0.46 | 1.01 | 1.01 |
| Uninsured | 65 | 11 | (6 to 16) | - | - | (- to -) | 86 | 19 | (10 to 28) | 0.012 | 0.058 | 1.06 | 1.05 |
| Region | |||||||||||||
| Northeast | 399 | 29 | (16 to 43) | 892 | 53 | (34 to 72) | 523 | 32 | (20 to 44) | 0.80 | 0.60 | 1.00 | 0.99 |
| Midwest | 292 | 22 | (12 to 32) | 801 | 49 | (33 to 65) | 722 | 38 | (25 to 51) | 0.027 | 0.193 | 1.03 | 1.01 |
| South | 503 | 28 | (18 to 39) | 926 | 35 | (22 to 48) | 1,531 | 47 | (35 to 59) | 0.05 | 0.43 | ||
| West | 442 | 32 | (22 to 42) | 586 | 36 | (23 to 48) | 1,029 | 59 | (28 to 90) | 0.22 | 0.21 | 1.03 | 1.03 |
| Office/clinic setting | |||||||||||||
| Urban | 1,244 | 26 | (21 to 32) | 2,991 | 46 | (37 to 54) | 3,555 | 47 | (38 to 57) | <0.001 | 0.027 | 1.03 | 1.02 |
| Rural | 391 | 35 | (18 to 52) | 214 | 20 | (11 to 29) | 269 | 26 | (11 to 41) | 0.31 | 0.126 | 0.98 | 0.96 |
| Physician specialty** | |||||||||||||
| Primary care | 806 | 28 | (19 to 38) | 1,614 | 41 | (30 to 53) | 1,160 | 28 | (20 to 36) | 0.93 | 0.99 | 1.00 | 1.00 |
| Cardiology | 617 | 693 | (510 to 876) | 1,264 | 767 | (568 to 966) | 2,210 | 1,089 | (841 to 1337) | 0.006 | 0.043 | 1.03 | 1.03 |
| Reason for visit | |||||||||||||
| Chest pain | 494 | 572 | (408 to 735) | 997 | 912 | (605 to 1219) | 1,085 | 1,075 | (846 to 1303) | 0.004 | 0.033 | 1.03 | 1.02 |
| Other | 1,141 | 20 | (15 to 25) | 2,209 | 29 | (23 to 36) | 2,721 | 32 | (25 to 40) | 0.006 | 0.40 | 1.03 | 1.01 |
| Smoker | |||||||||||||
| Yes | 185 | 28 | (16 to 39) | 451 | 51 | (33 to 69) | 515 | 55 | (38 to 72) | 0.059 | 0.27 | 1.03 | 1.02 |
| Unknown | 474 | 21 | (14 to 28) | 828 | 32 | (21 to 43) | 1,057 | 35 | (19 to 51) | 0.42 | 0.80 | 1.01 | 1.00 |
| No | 1,015 | 35 | (27 to 43) | 1,926 | 46 | (37 to 56) | 2,233 | 49 | (39 to 59) | 0.006 | 0.051 | 1.03 | 1.02 |
| Visit diagnosis | |||||||||||||
| Hypertension | 273 | 55 | (32 to 78) | 831 | 98 | (66 to 130) | 1,133 | 107 | (75 to 139) | 0.006 | 0.004 | 1.04 | 1.04 |
| Dyslipidemia | 141 | 121 | (73 to 169) | 397 | 123 | (60 to 186) | 620 | 120 | (81 to 159) | 0.38 | 0.74 | 0.98 | 0.99 |
| Diabetes | 117 | 36 | (18 to 53) | - | - | (- to -) | 253 | 49 | (33 to 65) | 0.30 | 0.51 | 1.03 | 1.02 |
| Obesity | 51 | 62 | (31 to 93) | - | - | (- to -) | 116 | 99 | (60 to 138) | 0.30 | 0.35 | 1.03 | 1.03 |
| Low risk visit€ | |||||||||||||
| Yes | 802 | 18 | (13 to 23) | 1,169 | 22 | (16 to 27) | 1,286 | 21 | (15 to 28) | 0.50 | 0.82 | 1.01 | 1.00 |
| No | 833 | 60 | (46 to 73) | 2,036 | 94 | (74 to 114) | 2,519 | 101 | (80 to 121) | 0.172 | 0.009 | 1.01 | 1.03 |
Abbreviations: CI, confidence interval; Avg., average; No., number; CHD, coronary heart disease; Thous., thousands; unadj., unadjusted; adj., adjusted
Includes only adults without a diagnosis of CHD. Trend analyses based on logistic regression models using all years of data, with adjustment for patient and provider characteristics. Time intervals exceed 3 years for some subgroups in order to construct reliable confidence intervals.
Cardiac stress test rate among all visits of adults without a diagnosis of CHD and falling within subgroup
Total no. of weighted visits resulting in a cardiac stress test order or performance
Time interval extends from 1993–1996 for non-Hispanic black and smoker; 1993–1997 for Hispanic and dyslipidemia; 1993–1998 for age>80 years; 1993–2001 for uninsured, diabetes, and obesity
Time interval extends from 1999–2004 for age>80 years. Data for uninsured, diabetes, and obesity captured in first and third time intervals.
Time interval extends from 2005–2010 for age>80 years; 2007–2010 for rural; 2002–2010 for uninsured, diabetes, and obesity.
Adult visits categorized as low-risk if patient was not a smoker, did not have chest pain, and had no diagnosis for hypertension, dyslipidemia, diabetes, or obesity.
Physician specialty available in NAMCS only